Acute renal failure in a case of nephrotic syndrome secondary to focal and segmental glomerulosclerosis

Nephrotic syndrome is infrequently complicated with appearance of acute renal failure and minimal change disease is the glomerulopathy more usually involved. Pathogenesis is unclear and three possible mechanisms it has been proposed to explain the decrease of glomerular filtration rate: a severe reduction of glomerular permeability, the presence of acute tubular necrosis or an increased intrarenal pressure related with interstitial oedema. Here we present a 36 years-old-male with a nephrotic syndrome caused by focal and segmental glomerulosclerosis who developed an anuric acute renal failure. Renal function did not change despite oedema removal with haemodialysis and only after corticosteroid and cyclophosphamide therapy introduction we observed a rapid recovery of urinary output and resolution of acute renal failure. Renal biopsy did not show signs of tubular damage or obstruction with proteins nor significant interstitial oedema. Therefore, in this case we think acute renal failure was caused by a severe reduction in glomerular ultrafiltration rate and steroids were the effective treatment that allowed recovery of renal function.     

In Silico identification of M. TB proteins with diagnostic potential

The development of a new tuberculosis (TB) vaccine has become one of the main objectives of the scientific community. Protein antigens have been widely explored as subunit TB vaccines, however lipid antigens could be equally important to be used or included in such a vaccine. The aim of this study was to demonstrate the potential of a liposome formulation composed of an extract of lipids from Mycobacterium smegmatis (Ms) as a TB vaccine candidate. We evaluated the immunogenicity of this formulation as well as the cross reactive response against antigens from Mycobacterium tuberculosis (MTb) in BALB/c mice. We determined the anti-liposome IgG response in sera from TB patients and from healthy subjects who displayed a positive (PPD+) or negative (PPD-) tuberculin skin test. A significant increase in anti-liposome IgG (p<0.05) was detected in animals immunized with Bacille Calmette-Guérin (BCG) compared with all groups, and in the group immunized with liposomes from Ms (LMs) compared to animals immunized with either LMs adjuvanted with aluminium (LMs-A) or the negative control group (phosphate buffered saline, PBS) respectively. With respect to the cross reactive response against a cocktail of cell wall antigens (CWA) from MTb, significantly higher IgG levels were observed in animals immunized with BCG and LMs compared to negative controls and either, aluminium-adjuvanted liposomes (LMs-A) or montanide (LMs-M) (p<0.05). Furthermore, the anti-liposome IgG response was significantly superior in sera from pulmonary TB patients compared to PPD+ and PPD- healthy subjects (p<0.001) suggesting the expression of these antigens in vivo during active MTb infection. The results obtained provide some evidence for the potential use of liposomes containing total lipid extracts of Ms as a TB vaccine candidate.

     

The need for patient-focused therapy for children and teenagers with allergic rhinitis: a case-based review of current European practice

Allergic rhinitis is a common problem in childhood and adolescence, with a negative impact on the quality of life of patients and their families. The treatment modalities for allergic rhinitis include allergen avoidance, anti-inflammatory symptomatic treatment and allergen specific immunotherapy. In this review, four cases of children with allergic rhinitis are presented to illustrate how the recently published EAACI Guidelines on Pediatric Allergic Rhinitis can be implemented in clinical practice.     

Assessment of female prevalence of overactive bladder (OAB) in Barcelona using a self-administered screening questionnaire: the Cuestionario de Autoevaluación del Control de la Vejiga (CACV)

Introduction and hypothesis

Overactive bladder (OAB) syndrome is common urological condition, usually underdiagnosed and difficult to identify. The screening of lower urinary tract symptoms (LUTS) through patient self-administered questionnaires can be useful not only for timely identification of these patients but to implement early interventions for symptoms and their implication in a patients’ quality of life (QOL). Our objective was to assess the prevalence of OAB symptoms in patients attending general gynecology units in Barcelona, Spain, through a self-administered screening questionnaire.

Materials and methods

A cross-sectional, multicenter, observational, epidemiological study was carried out at general gynecology units of ten primary health centers in Barcelona, Spain. The study was conducted during a patient’s single visit through self-administered forms. Patients recorded sociodemographic data, medical history and comorbidities, and scored the presence and bother related to specific urological symptoms using the Cuestionario de Autoevaluación del Control de la Vejiga (CACV), the validated Spanish version of the Bladder Control Self-Assessment Questionnaire (B-SAQ). A score ≥6 on the symptoms scale of the CACV was taken as an indicator of suspected OAB.

Results

One thousand and four women aged between 18 and 82 participated in the study. The overall prevalence of OAB was 11.8 %. A patient being >50 years was significantly associated with suspected OAB in comparison with the younger group [odds ratio (OR) 3.1 (2.1–4.7); p?<?0,001]. Overactive bladder showed significant association with factors other than age, menopause, and previous urogynecological history, such as high body mass index (BMI) and parity.

Conclusions

The estimated prevalence of suspected OAB in patients attending general gynecological services in Barcelona is 11.8 %. Overweight or obese patients and those with three or more children were found to be at elevated risk for developing OAB.     

IgG subclass profile among anti‐Glutathione S‐transferase T1 antibodies in post‐transplant de novo immune hepatitis

Although the pathogenic pathways leading to de novo immune hepatitis (IH) are not completely understood, we have shown strong evidences of an antidonor response against Glutathione S‐transferase T1 (GSTT1), an antigen exclusively expressed in the donor liver. The first sign of this process is the production of GSTT1 antibodies that, in 25% of the cases, will precede de novo IH. Because the presence of the antibodies is not sufficient to trigger the disease, we aimed to study GSTT1 IgG subclasses in a group of 18 liver transplant patients, 12 that developed de novo IH and 6 that remained free of disease. Surprisingly, the predominant subclasses were IgG1‐_GSTT1 and IgG4‐_GSTT1. The presence of IgG4‐expressing plasma cells was also investigated in 10 available liver biopsies. Six biopsies coinciding with diagnosis showed a mean value of 32.8 IgG4+ plasma cells/hpf vs. 5.55 in patients without the disease. We have not found a distinctive GSTT1‐IgG profile in patients with de novo IH, but the ratio IgG1‐_GSTT1/IgG4‐_GSTT1 in samples from close to the time of diagnosis seemed to be important. The novel finding of abundant IgG4‐_GSTT1 in liver transplantation is intriguing, but their possible role in pathogenesis of de novo IH remains unknown.     

Comparing two botulinum toxin type A formulations using manufacturers' product summaries

Background and objective: Because of the unique pharmacology and clinical versatility of botulinum toxin (BoNT), particularly BoNT serotype A (BoNTA), a need exists for discussion of the current data on similarities and differences between two BoNTA products, BOTOX and Dysport. Methods: We compared the physiochemical and pharmacological properties of BOTOX and Dysport using information from the Summary of Product Characteristics (SmPC) documents from a number of countries around the world. Results and discussion: Our analysis based on the SmPC documents demonstrated distinct differences in physical characteristics, breadth of approved indications, dosing and administration, and the incidence and severity of adverse events. Conclusion: BOTOX and Dysport are not bioequivalent. Many of the differences between BOTOX and Dysport discussed within are probably related to the differences in their physical characteristics.     

Can the cold pressor test predict future cardiovascular events in patients without demonstrated ischemic heart disease by SPECT?

Objective

To assess whether a cold pressor test (CPT) could help identify patients at a high risk of cardiovascular events in a population without known coronary artery disease (CAD) with a normal myocardial perfusion scintigraphy (MPS).

Methods

Our population consisted of 870 patients with a mean age of 59.3 years with several CAD risk factors, having been referred for an MPS. The CPT was performed between the third day and fifth day after the MPS.

Results

The CPT was positive in 38.2% of the patients. After a mean 40-month follow-up, the patients were contacted to check for cardiac death, non-fatal myocardial infarction, and myocardial revascularization procedures. The event-free survival rates were 98.1% and 90.4% after a negative or positive CPT, respectively (p = 0.0001). The positive CPT group exhibited a fourfold increased risk of CV events. All CV events in the negative CPT group occurred after a 30-month follow-up. The risk of CV events was 4.5 times higher in diabetic patients.

Conclusion

A positive CPT in patients with a negative MPS could help identify a subgroup of patients at a higher risk of developing symptomatic CAD.

Practice implications

Our results suggest that after a normal post-exercise MPS, patients should undergo a CPT.     

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early‐childhood and school settings as well as providers of non‐prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast‐food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto‐injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision‐making on legislation at local and national level.